<!DOCTYPE html>
<html lang="en">
<head>
    <meta charset="UTF-8">
    <title>Title</title>
</head>
<body>
    <table width="100%" border="0"cellspacing="0" cellpadding="0">
        <tr bgcolor="#a9a9a9">
            <td width="15"><img src="res/img/28.gif" width="10" height="10"></td>
            <td valign="bottom">门诊挂号</td>
        </tr>
    </table>
    <br>
    <table width="95%" align="center" cellpadding="0" cellspacing="0" border="0" bgcolor="#E4EFF7" >
        <tr>
            <td bgcolor="#C3DAF2" align="center" width="25%" height="20">挂号单编号</td>
            <td width="25%"><input name="t1" type="text" class="input"></td>
            <td bgcolor="#C3DAF2" align="center" width="25%">门诊类型</td>
            <td width="25%">
                <select name="select">
                    <option>普通门诊</option>
                    <option>特需门诊</option>
                    <option>专家门诊</option>
                </select>
            </td>
        </tr>
        </table>
        <br>
    <table width="95%" align="center" cellpadding="0" cellspacing="0" border="0" bgcolor="#E4EFF7" >
        <tr>
            <td bgcolor="#C3DAF2" align="center" width="25%" height="20">就诊卡号</td>
            <td width="25%"><input name="t1" type="text" class="input"></td>
            <td bgcolor="#C3DAF2" align="center" width="25%">姓名</td>
            <td width="25%"><input name="t1" type="text" class="input"></td>
        </tr>
    </table>
    <br>
    <table width="95%" align="center" cellpadding="0" cellspacing="0" border="0" bgcolor="#E4EFF7" >
        <tr>
            <td bgcolor="#C3DAF2" align="center" width="25%" height="20">性别</td>
            <td width="25%">
                <input type="radio" name="nan" checked>男
                <input type="radio" name="nan" checked>女
            </td>
            <td bgcolor="#C3DAF2" align="center" width="25%">年龄</td>
            <td width="25%"><input name="t1" type="text" class="input"></td>
        </tr>
    </table>
    <br>
    <table width="95%" align="center" cellpadding="0" cellspacing="0" border="0" bgcolor="#E4EFF7" >
        <tr>
            <td bgcolor="#C3DAF2" align="center" width="25%" height="20">挂号科室</td>
            <td width="25%">
                <select name="select">
                    <option>内科</option>
                    <option>外科</option>
                    <option selected="selected">儿科</option>
                    <option>妇产科</option>
                    <option>骨科</option>
                    <option>眼科</option>
                    <option>口腔科</option>
                    <option>五官科</option>
                    <option>肿瘤科</option>
                    <option>皮肤病科</option>
                    <option>中医科</option>
                </select>
            </td>
            <td bgcolor="#C3DAF2" align="center" width="25%">挂号类型</td>
            <td width="25%">
                <select name="select">
                    <option>普通挂号</option>
                    <option>快速挂号</option>
                    <option selected="selected">专家教授</option>
                    <option>急诊挂号</option>
                    <option>简单挂号</option>
                </select>
            </td>
    </table>
    <br>
    <table width="95%" align="center" cellpadding="0" cellspacing="0" border="0" bgcolor="#E4EFF7" >
        <tr>
            <td bgcolor="#C3DAF2" align="center" width="25%" height="20">就诊医生</td>
            <td width="25%"><input name="t1" type="text" class="input"></td>
            <td bgcolor="#C3DAF2" align="center" width="25%">挂号时间</td>
            <td width="25%"><input name="t1" type="text" class="input"></td>
        </tr>
    </table>
    <br>
    <table width="95%" align="center" cellpadding="0" cellspacing="0" border="0" bgcolor="#E4EFF7" >
        <tr>
            <td bgcolor="#C3DAF2" align="center" width="25%" height="20">操作人员</td>
            <td width="75%"><input name="t1" type="text" class="input"></td>
        </tr>
    </table>
    <br>
    <table width="95%" border="0" align="center" cellpadding="0" cellspacing="0">
        <tr>
            <td align="center"><input name="submit" type="button" class="buttonface" value="  提交  " onClick="window.location.href='P_infor.jsp'">
                &nbsp;&nbsp;&nbsp;&nbsp;
                <input name="reset" type="button" class="buttonface" value="  返回  " onClick="window.location.href='P_infor.jsp'"></td>
        </tr>
    </table>
</body>
</html>